Does Phosphodiesterase Inhibition Lessen Facial Flap Necrosis in Tobacco Cigarette Users?

Abstract

Tobacco cigarette smoking remains a serious risk factor for necrosis of local facial skin flaps. To date, no pharmacological therapies exist for cigarette smoke-induced impairment of skin flap tissue survival. Accumulating evidence suggest that phosphodiesterase-5 (PDE-5) inhibitor therapy may counteract the negative effects of cigarette smoke on flap survival. Here, we evaluate skin flap survival in a series of consecutive tobacco cigarette users treated with the PDE-5 inhibitor, sildenafil, who underwent local flap facial reconstruction. We included 11 patients (5 females; median age: 64) with a significant smoking history. Seventeen facial flaps were performed for 14 defects. All patients received sildenafil in the postoperative setting. One complication of necrosis of the flap distal margin was encountered. Follow-up was available for all patients. Our results demonstrate that facial reconstruction in tobacco cigarette smokers can be performed with improved success and that sildenafil therapy may mitigate the deleterious effects of smoking on flap survival.

Use of Phosphodiesterase Inhibitors in the Postoperative Period of Skin Flaps: A Systematic Review

“…The dose used was 100 mg/kg, once a day, 30 days before surgery, and 7 days after surgery. 6 Although there are articles showing the improvement of flap circulation in smokers with the use of PDE inhibitors, 13,15 these results should be interpreted with caution, since in practice we observe catastrophic results in skin flaps, even in clinical patients who are healthy and nonsmokers. The orientation to stop smoking 4 weeks before and after the procedure should prevail in clinical-surgical practice.…”

Effects of sildenafil and tadalafil on skin flap viability

“…Despite the clinical application in an empirical way, there are few publications that report the use of five phosphodiesterase inhibitors to improve the skin flap viability [ 37 ].…”

Tadalafil to improve cutaneous flap perfusion in smokers: A case series and literature review

“…Oral, topical, and locally injected PDE5 inhibitors have been demonstrated to increase the perfusion and viability of ischemic flaps in rat models. 2 , 3 , 4 , 5 , 6 In 2014, Pfaff et al 7 demonstrated that facial reconstruction with flaps in smokers may have improved clinical outcomes with sildenafil 20 to 50 mg, 1 to 3 times daily for 1 to 7 days, starting on POD 0 or 1.…”